Document resource
Background Cardiac disease is common in those with COPD, who have double the odds of cardiac arrhythmias compared to those without COPD. 1 We used ambulatory cardiac monitoring to investigate if arrhythmias occurred during periods of disease stability in people with COPD.Methods Patients enrolled within the London EXCEL COPD cohort were reviewed at disease stability: had blood samples taken, performed post-bronchodilator spirometry, and instigated 7-day ambulatory cardiac monitoring (Eclipse™ Pro, Spacelabs Healthcare, USA). We used longitudinal data for the number of exacerbations in the prior 12 months. Atrial fibrillation (AF)-like activity was defined as irregular ventricular response to atrial driven activity with no discernible p waves for <30s. Frequent premature atrial complexes (fPAC) were defined as any period of ≥30 premature atrial complexes (PACs)/hour. Frequent premature ventricular complexes (fPVC) were defined as premature ventricular complexes (PVCs) being >20% of total complexes.Results Interim results include twenty-two patients (median age: 73.3 (IQR:69.2 – 76.3) years, 11 (50%) male, median FEV 1 %predicted (n=21): 67.2 (IQR:52.5 – 69.3), median troponin: 4.1 (IQR: 3.2– 5.8) ng/L, median brain natriuretic peptide (BNP): 33.0 (IQR:22.3 – 83.8) ng/L) who completed ambulatory cardiac monitoring; median duration was 169.5 (IQR 167.0 –177.8) hours. Eight (36%) had ≥2 exacerbations in the previous 12 months. The frequency of arrythmias present is shown in table 1. There was no association with presence of supraventricular tachycardia (SVT), non-sustained ventricular tachycardia (NSVT), AF-like activity or fPAC and FEV1%predicted, exacerbation frequency or BNP. Median troponin was higher in those with SVT than without (p= 0.022).Abstract S99 Table 1Presence of arrythmias during 7-day cardiac monitoring in stable COPD N (%) (study population, n = 22) ≥one SVT period 12 (55) ≥one NSVT period 6 (27) AF-like activity 3 (14) Either ≥one SVT period OR ≥one NSVT period 14 (64) Neither SVT nor NSVT 8 (36) Either ≥one SVT period OR ≥one NSVT period OR AF-like activity 16 (72) fPAC 7 (32) fPVC 0 Conclusions Cardiac arrhythmias are common during COPD disease stability with 16 (72%) patients having one or more of SVT, VT or AF-like activity and 7 (32%) having fPAC. This may reflect undiagnosed underlying structural heart disease, possibly worsened by COPD, and potentially benefitting from cardiac imaging assessment.Reference Chen W, et al. Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Lancet Respir Med. 2015;3(8):631–9.